Deeper Dive

Recognizing Chicago as one of the nation’s most segregated cities, with some of the most dramatic differences in life expectancy across neighboring communities, Healthy Chicago 2.0 is a sweeping initiative that brings partners together to drive an agenda built on 200 specific actionable strategies to improve health equity throughout the city. “The plan made it clear that we were putting a stake in the ground to really address social determinants of health and disparities,” said Julie Morita, MD, Commissioner of the Chicago Department of Public Health until early 2019.

The Importance of Process

To lay the groundwork for Healthy Chicago 2.0, CDPH went well beyond the approach used in a traditional community health needs assessment or community health plan. An early assessment engaged nearly 1,000 stakeholders—residents, health care providers, government agencies, community and social service organizations, foundations and public health experts— to review data that told the story of health inequities in Chicago and then to identify 10 priority areas for action.

All of our objective measures say that there are these deep inequities based on where we live. We really moved into a space of saying ‘this isn’t a naturally occurring disparity. There is a causal mechanism here. Anne Posner, Chicago Department of Public Health

Selected priorities ran the gamut from improving education and increasing access to health care and human services to strengthening social, economic and community conditions and expanding partnerships and community engagement. Ten action teams, each co-chaired by a CDPH staff person and a community partner, were then formed to focus on each priority. For five months, these teams continued to consult with stakeholders as they engaged in a deep and thoughtful process and emerged with a package of specific goals, objectives, strategies and metrics that became Healthy Chicago 2.0.

Because so many different sectors had been involved in the early development of the plan, “they felt some responsibility for accomplishing what is in it,” said Morita. “I can’t overestimate how much that plan made a difference in terms of guiding and informing the work we were doing.”

Meanwhile, a Health in All Policies resolution, supported by the Mayor and passed by the City Council in June 2016, highlighted the responsibility of government agencies to view health through a wide-angle lens. A task force made up of the commissioners of every department, and coordinated by CDPH, created a forum for developing high-level recommendations about how department can collaborate to institutionalize the new resolution.

That support from City Hall, coupled with the Healthy Chicago 2.0 process that swept public, private and nonprofit leaders together, sent a message that health equity was integral to everyone’s mission.

Public Health Gets Under the Tent

The framework also gave the public health department its calling card. “Bringing new partners to the table built a lot of momentum and good will,” explained Megan Cunningham, JD, managing deputy commissioner of CDPH. “We were really able to start to tell the story of how public health adds value.”

That didn’t mean other sectors headed right to the public health department to ask for its involvement. “We could not be passive and wait for them to come to us. It required active pursuit on our part,” Morita realized. Health officials devoted quite a bit of time to outreach, putting out messages like “we would like to be part of this conversation,” “we want to support you on this,” and “here is an opportunity, what do you think?”

When we present ourselves to the Department of Transportation or the Department of Planning or Health and Human Services, we say, ‘we are here because your work impacts health. We would like to collaborate with you. Julie Morita, Chicago Department of Public Health

Sometimes, a public health official would knock on a door or arrive at a meeting only to have participants look at one another as if to say, “what is health doing here?” recalled Anne Posner, MSW, CDPH’s Director of Health Equity and Strategic Partnerships. The reality, she said, is that “we have to keep proving our value.”

But relationships built over time. In dialog with potential partners, CDPH highlights two particularly valuable assets: its data expertise and the breadth of its connections. The message, Morita said, is “we can bring data to monitor, influence and inform your decisions and evaluate your programs. And we can bring partners to your endeavors who might be nontraditional partners for you.”

With word spreading about its contributions, advocates and government agencies began thinking more routinely about enlisting CDPH. Representatives of the Metropolitan Planning Council, which focuses on economic development and building vibrant neighborhoods, were impressed by its health impact assessment of a bike and walking trail in a community with limited recreational facilities. Seeing how its data could inform local issues, the Council asked CDPH to assess the health implications of redeveloping an old bank. “Every table gets you to another table,” observed Cunningham.

The department’s ability to link stakeholders is also a potent asset. For example, a local community development group wanted CDPH to introduce them to the Chicago Department of Planning so they could discuss the health benefits of a certain approach to developing a site. “We can be that central partner, helping the community engage with government partners,” Morita said. “And we can help link our government partners with community people who hadn’t had those relationships previously.”

From Plan to Action

Healthy Chicago 2.0 singles out four key social determinants for special attention: housing, education, the built environment, and economic development.

One plan goal is to “create and maintain affordable, safe, healthy, accessible and supportive housing.”
To push that agenda forward, CDPH collaborated with the Corporation for Supportive Housing, the Center for Housing and Health, and other nonprofit agencies, and with city departments, including the Housing Authority, Health and Human Services, and Family and Support Services, which serves homeless populations. Based on a model developed in Los Angeles, the partners created a Flexible Housing Pool to pay for supportive housing and services to high-need individuals, including those with serious mental illnesses, substance disorders and involvement with the justice system.

The goal is to draw on a mix of public, philanthropic and health system resources to develop 750 units of supportive housing. An early success was securing a funding contribution from Cook County Health and Hospital Systems, which stands to save money by reducing the pressure from high service utilizers. “Usually the county and the city don’t play all that well together in the funding space,” acknowledged Cunningham. “So that’s a big win for us.”

Another initiative with significant involvement from CDPH is Elevated Chicago, a package of community-led initiatives designed to revitalize seven neighborhoods within half a mile of transit stations, lifting up racial equity while avoiding residential displacement. Elevated Chicago is one of six projects funded as part of the nationwide Strong, Prosperous and Resilient Communities Challenge (SPARCC) to ensure that major new capital investments promote equitable and healthy opportunities for all.

CDPH was “one of the founding mothers” of Elevated Chicago, along with the Chicago Community Trust, policy think tanks, and community development institutions, said Roberto Requejo, MUPP, the program’s executive director. “SPARCC created a need to bring together public health experts, housing and built environment experts, climate change folks, and racial equity organizations,” he said. “The process of developing the application was so collaborative and so deeply engaged by all of the members that the relationships created at both the personal and organizational level are still linked today.“

Everybody at our table has gone through that a-ha moment, whether as a neighborhood-based organization or a policy think tank, where they realize, ‘we have completely forgotten about health indicators in our work. We thought someone else was handling that. Roberto Requejo, Elevated Chicago

Many of Elevated Chicago’s passions – especially its commitment to community engagement and racial equity – are echoed at CDPH. Health department staff lead its Knowledge Sharing Working Group, providing a department-funded epidemiologist to head a mapping process, and also serve on the Capital & Programs and Systems Change Working Groups. Equally important, they have provided entrée into the halls of government. Referring to passage of an ordinance requiring equity in transit-oriented development, Requejo said, “We wouldn’t have gotten there so fast if we had not had door openers at the health department who made sure we didn’t miss any of the conversations that were happening.”

CDPH is also an essential player in the evolving effort of health systems to align with Healthy Chicago 2.0. In 2017, Rush Medical Center invited representatives from other local hospitals to convene a community meeting on its home territory of the West Side, which has some of the city’s worst health indicators. The public health department was there, as were numerous civic leaders, all helping to give birth to West Side United. “We realized that the approach to health has to address more than health care if we are going to improve outcomes,” said David Ansell, MD, MPH, senior vice president for community health equity at Rush, which has made an explicit commitment to serve as an “anchor institution” on the West Side.

If you were to give everyone in the US a statin for high cholesterol, life expectancy would be raised on average by 20 minutes. Yet if you can move people from the conditions in Garfield Park to those in Lincoln Park, you can get 16 to 25 years more. David Ansell, Rush Medical Center

With health systems, community-based organizations and government partners at the table together, West Side United works in four broad domains to revitalize the community—health and health care; neighborhood and physical environment; economic vitality; and education. In 2019, JPMorgan Chase & Co. awarded the coalition a three-year, $3 million grant, which it will use to boost training for health care workers and create more living-wage jobs. Reflecting on how much power a network can wield, Ansell observed, “Where we have moved the dial on public health outcomes, they were multi-partner, multi-sector projects and they set big audacious goals and aims.”

As a catalyst, supporter, or leader, CDPH is involved again and again in those kinds of cross-sector efforts to bring the Healthy Chicago 2.0 vision to fruition. And yet its willingness to step back and not claim credit for some of the work is one reason for its success. Sometimes, Anne Posner said, the implicit message to a partner should be, “We don’t have to be the face of your movement, we want to support the work you are doing.”

Another key to working effectively across sectors? “A sincere humility,” she advised. “Trying to come into some of these spaces acknowledging that this is not an area of our traditional expertise. Our message is ‘here is the value that public health brings and here is where we really want to learn from you.’”